There are a variety of tools available to assess asthma control, including the Asthma Control Test (ACT), the Asthma Control Questionnaire (ACQ), and the Asthma Impairment and Risk Questionnaire (AIRQ). Here’s a look at how they work.
Asthma Control Assessment: To ACT, ACQ, or AIRQ?
Despite advancements in available medications to manage asthma, the substantial burden of this disease continues to affect millions of patients worldwide. Hallmark symptoms such as wheezing, coughing, and shortness of breath are attributed to bronchoconstriction.
And even though there are tools available like the Asthma Control Test (ACT) and the Asthma Control Questionnaire (ACQ), assessing asthma control has been overestimated by patients, physicians, and caregivers alike. A potential solution to better estimate asthma control may be the Asthma Impairment and Risk Questionnaire (AIRQ)®.
Similarities and Differences Between Asthma Control Assessments
The ACT and ACQ have been widely used in clinical practice and research to assess asthma control, while the AIRQ is an emerging tool. So what are the similarities and differences between these tools, and how does the AIRQ compare? A summary of common tools to assess asthma control appears in Table 1 below.
The biomedical literature of each assessment is mixed; for example, some healthcare practitioners prefer the ACT to the ACQ. Other research found that neither the ACT nor the ACQ is useful for the assessment of uncontrolled asthma.
Some advantages and drawbacks for these mainstay assessments are highlighted below:
ACT: The ACT has diagnostic accuracy for the assessment of controlled asthma. It assesses the frequency and severity of symptoms, limitations on daily functioning, lung function, and use of rescue medication. It also has a utility in clinical trial settings to measure overall asthma impact, and it correlates well with other measures of asthma impact, such as the Asthma Quality of Life Questionnaire (AQLQ) and the Medical Outcomes Survey Short Form-36 (SF-36). However, assessment of future risk of exacerbations are lacking, and the use of a Likert scale to score assessment may be challenging for some patients to differentiate between.
ACQ: The ACQ is diagnostically accurate for assessing not well-controlled asthma at prespecified cutoff points. It assesses symptom frequency and severity, lung function, sleep disturbance, activity limitation, airway hyperresponsiveness, and use of rescue medication. Like the ACT, however, it lacks assessment of risk of future asthma exacerbations. Additionally, the short period of recall of one week may not be enough, and the use of the Likert scale as a measurement tool may also be challenging.
AIRQ: The AIRQ was developed by a network of US-based scientific experts and primary- and specialty-care clinicians to address the rising morbidity from uncontrolled asthma. The questionnaire measures asthma control based on impairment and risk domains. Impairment measures the frequency and severity of asthma symptoms, its impact on daily activities, and the use of rescue medications, while the risk domain measures exacerbation risk, use of corticosteroids, emergency care sought, and hospitalization. Ten yes/no responses make it easier for self-assessment. The time frame of recall and risk includes two weeks to 12 months, respectively, which may be advantageous. Lastly, there are highly significant correlations between AIRQ score and patient self-perception of overall control, total SGRQ, mini-AQLQ, and AAAQ scores.
Table 1. Summary of Asthma Control Assessment Tools
| Asthma Control Test (ACT) | Asthma Control Questionnaire (ACQ) | Asthma Impairment and Risk Questionnaire (AIRQ) |
# of Questions, Response Format | 5-items Likert scale (1-5) | 7-items Likert scale (1-7) | 10-items, yes/no |
Domains | Symptoms and limitations | Symptoms only | Impairment and risk |
Score | 5 - 25 | 0 - 6 | 0 - 10 |
Literacy Level (Flesch-Kincaid Grade Level, Readability) | Grade 6.2 Readability: 70.3
| Grade 8.4 Readability: 66.3 | Grade 5.8 Readability: 72.6
|
Age Applicability | 12+ years old | ||
Administration | Self-assessment | ||
Interpretation | Lower score may indicate worse asthma control | Higher score may indicate worse asthma control | Higher score may indicate worse asthma control |
Assessment Timeframe | Past 4 weeks | Past week | Past 2 weeks and 12 months |
Implications in Patient Care
The use of tools like the AIRQ, ACT, and ACQ can have a significant impact on patient care as it enables healthcare providers to effectively identify patients who are at risk. As a result, treatment plans can be tailored to meet the specific needs of each patient so that their quality of life can be improved. The choice of which tool to use will depend on the specific needs of the patient and the healthcare provider.
The place of the AIRQ in assessing asthma is yet to be determined, but findings suggest that the AIRQ is a valid tool for assessing asthma control and can provide useful information regarding patient perception of disease status, health-related quality of life, and treatment adherence.
REFERENCES
Jia CE, Zhang HP, Lv Y, et al. The Asthma Control Test and Asthma Control Questionnaire for assessing asthma control: Systematic review and meta-analysis. J Allergy Clin Immunol. 2013;131(3):695-703. doi:10.1016/j.jaci.2012.08.023
Reibman J, Chipps BE, Zeiger RS, et al. Relationship Between Asthma Control as Measured by the Asthma Impairment and Risk Questionnaire (AIRQ) and Patient Perception of Disease Status, Health-Related Quality of Life, and Treatment Adherence. J Asthma Allergy. 2023;16:59-72. doi:10.2147/JAA.S373184
Rhee H, Love T, Mammen J. Comparing Asthma Control Questionnaire (ACQ) and National Asthma Education and Prevention Program (NAEPP) asthma control criteria. Ann Allergy Asthma Immunol. 2019;122(1):58-64. doi:10.1016/j.anai.2018.09.448
van Dijk BCP, Svedsater H, Heddini A, Nelsen L, Balradj JS, Alleman C. Relationship between the Asthma Control Test (ACT) and other outcomes: a targeted literature review. BMC Pulm Med. 2020;20(1):79. doi:10.1186/s12890-020-1090-5
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